Abstract 3587: Prevalence of Unrecognized Renal Insufficiency in Hospitalized Patients with Heart Failure: Implications for Outcome
Background- Renal insufficiency (RI) is a strong predictor of adverse cardiovascular outcomes in pts with heart failure (HF). The aims of our study were:
to investigate the awareness of hospital physicians to diagnosis of RI in a broad unselected population of hospitalized HF pts;
to determine whether unrecognized RI is associated with same adverse prognosis.
Methods and Results - We analyzed data from a prospective national cohort survey of 4,102 hospitalized pts with HF. We tested the sensitivity of diagnostic codes for RI (extracted from medical chart diagnosis lists) for detecting RI. True prevalence of RI was determined according to US National Kidney Foundation criteria [estimated glomerular filtration rate (eGFR)<0 ml/min/1.73m2]. GFR could be estimated for 3,793 (98%) of the patient cohort. RI (eGFR<0 ml/min/1.73m2) was present in 2,145 (57%) of them. Presence of RI was not recognized in 872/2145 (41%) pts (53% with moderate and 5% with severe RI). Pts with unrecognized RI were much more likely to be women (61% vs. 36%, respectively, p=.001), older (mean age 78±0 vs. 76±0, p,.001), and with a better functional class (58% vs. 44% in NYHA I-II, p=.001) compared with those pts with recognized RI. In total, 181 pts died during the index hospitalization and 1072 during the first year after admission. Pts with both recognized and unrecognized RI had significantly higher crude mortality rates compared with pts with preserved renal function: 6.5% and 7.1% vs. 2.1% for in-hospital mortality and 30.9% and 38.8% vs. 18.8% for 1-year mortality, respectively [all with p(log rank test)<001]. By multivariate analysis, recognized and unrecognized RI were significant and similar independent predictors of adverse prognosis: OR (95% confidence interval)=.34 (1.43–3.87) and 2.30 (1.45–3.72) for in-hospital mortality and 1.22 (0.97–1.53) and 1.79(1.45–2.20) for 1-year mortality.
Conclusions: A high proportion (41%) of prevalent renal insufficiency remains clinically unrecognized among hospitalized HF pts. As renal insufficiency is associated with an increased risk of death, our data suggest a need for careful screening to recognize renal insufficiency and to apply effective preventive treatment in those high risk patients.